Attitudes

CPD Log

Show Notes

Definition

What are non-motor symptoms?

In PD there is a diverse range of symptoms which reflect the widespread neurochemical and neuroanatomical changes that occur throughout the course of Parkinson’s disease.

There is involvement of not only the dopaminergic nigrostriatal system, but also serotonergic and noradrenergic brainstem areas, cholinergic frontal and brainstem regions. These all lead to slightly different symptoms which can broadly be divided into those relating to movement (so called Motor) and those related not to movement (the non-motor).

Main Discussion

Pre-diagnostic phase

From observational and longitudinal studies, several non-motor features affecting smell, mood, sleep, and autonomic function have now been linked to the risk of the development of Parkinson’s disease and neurodegenerative diseases.

Other non-motor symptoms such as cognitive impairment, autonomic dysfunction, and sleepiness have been identified early in de novo, untreated Parkinson’s disease patients.

(NERD ALERT)

In PD, α-synuclein adopts a β-sheet-rich amyloid-like structure that is prone to aggregate. Indeed, misfolded α-synuclein is found within Lewy Bodies.

different forms of α-synuclein are found in the PD brain – including unfolded monomers, soluble oligomers, protofibrils, and high molecular weight insoluble fibrils.

Recent studies in rodents indicated that the most neurotoxic α-synuclein species is the early oligomeric form, rather than the mature insoluble fibrils.

The oligomeric species of α-synuclein are capable of “seeding” and accelerating abnormal protein aggregation and it is proposed that this might be the mechanism underlying the spread of α-synuclein pathology in the brain

However it’s not just the brain…

α-synuclein deposition is observed in several peripheral organs, including the retina, the uterus, the bladder, the skin, parts of the cardiovascular system (predominantly in the aorta and heart ventricles), and the gastrointestinal system, particularly in the submandibular gland, stomach, and the bowels..

This points to a significant involvement of the peripheral nervous system in PD and raises the question of whether α-synuclein pathology originates in the brain or in the periphery.

This book chapter explores the pathogenesis of PD very well – needless to say it’s quite complex and not a simple story!

Key Messages: NMS are generally prevalent and highly burdensome within selected Asian PD populations living in countries. It is suggested that NMS-driven phenotypic heterogeneity is present in Asian patients, and compared to Western PD populations there might be variations in assessed NMS.

As PD progresses, it is common knowledge that a problem can occur known as the “on-off” phenomenon. The same can happen with NMS and can be equally disabling. Symptoms can be a worsening of something that is there already – or a new symptom that only comes during the off period.

Some specific NMS

We will focus on a few NMS and look at the management plans.

The MDT has a significant role to play: SaLT, PD nurses, bladder and bowel services, PT, OT, medics and support groups.

Physical activity may be a suitable non-pharmacological therapy in PD. Global and specific NMS involving depression, apathy, fatigue, cognition, and sleep were significantly improved by some form of physical activity.